Birth through 1 month of age
- Oral stage
- Aware of inanimate vs animate
- Social interaction
- Eye-hand coordination
- Lifts head when prone
- Head lag, can turn head
- Sucking and rooting reflexes
- Gains 5-7 ounces a week
- Trust vs mistrust
- Sense: hearing, taste, smell, vision
2-4 months of age
- Lifts head 45 degrees when prone, holds head steady by 4 months
- follows moving objects with eyes
- recognizes familiar faces
- vocalizations by 2 months, squeals by 4 months
- smiles, laughs to show pleasure
- drools, chews, bites by 4 months
- 2-3 months- cooing sounds
- Hearing - turns eyes and head towards sounds
- Vision: begins to show interest in hands, recognizes familiar objects, can see full color by 6 months
5-8 months of age
- first tooth
- sleeps through the night
- weighs 2 x birthweight
- Rolls from back to stomach
- starts to imitate sounds, babbles
- sits well alone by 8 months
- begins to show patterns of regular bladder and bowel elimination
- responds to “no”
- vision: depth perception; both eyes focus
9-11 months of age
- creeps and crawls; good coordination, sits alone
- responds to adult anger with cries
- drinks from a cup with assistance
- pulls self to standing position
- begins to show fear of going to bed alone
- pincer grasp (thumb and finger)
- sits by falling down
- understands bye bye
- attempts to walk by 11 months
- eruption of lower incisor
- initiates vocalizations 2-3 syllable sounds
- imitates simple words and sounds
- vision: peripheral vision is well developed; judges distances
12-15 months of age
- Loses Babinski’s sign by 12 months
- weighs triple birthweight by twelve months
- develops ability to shiver by 12 months
- can say mama and dada
- knows their own name
- Can use a spoon
- Drinks from a cup by themselves
- shakes head for no
- tolerates some separation
- has temper tantrums
- walks without help
- follows simple directions
- vision: ability to identify shapes; hand eye coordination
16-18 months of age
- closed anterior fontanel
- walks up stairs without help
- turns pages of a book
- begins to test limits
- has bowel movements when helped to the potty
- places objects into a hole or slot
- becomes communicative
Nutrition
- first 6 months: 125-150 kg for fluids a day, decreased to 120-135 kg per day in second 6 months
- Vitamin D supplements for breastfeeding babies
- breastfeeding most important for the first 6 months
- AAP and American dietetic association: breast feed for 12 months
- WHO and Unicef: 2-3 years
Breastfeeding
- Healthy people 2020 - increase breastfeeding to 81.9% of infants as goal
- WHO recommends: have a lactation program at the birthing hospital; encourage breastfeeding 30 minutes after birth; encourage breastfeeding on demand
Solid food
Being at 4-6 months when infant is dev ready (aap recommends 6 months to decrease change of allergies)
- introduced food in the following order: cereals, veggies/fruit, strained meats
- do not give honey until after 12 months of age
- let infant start to use a cup at 5-6 months
Eliminaton
-stool, urine
The period of Purple Crying
P: beings at 2 weeks - continues 3-4 months
U: unexpected crying can come and go, you don’t know why
R: resists soothing, no matter what you try
P: pain like face- even when the infant is not in pain
L: long lasting crying as much as 5 hours a day, or more
E: evening crying may be prevalent
Sleep
- Nocturnal sleep patterns by 3-4 months
- 4 months: sleeps 9-11 hours at night, 2 naps during the day (14-15 hours total)
- 12 months: sleeps through the night, 1-2 naps during day
SIDS
Sudden Infant Death Syndrome
- one of the leading causes of infant mortality prior to 12 months
- 4th leading cause of infant death in US and leading cause in infants 28-364 days of age
- Safe to sleep program
- Healthy people 2020 goal: reduce SIDS to .5 infant deaths/1000 live births
- African american and American Indian/Alaska Native infants are at higher risk
Etiology of SIDS
UNEXPLAINED
- positioning - side lying or prone
- preterm birth
- smoke exposure
- soft bedding
- bed sharing
- overheating
- Not breastfeeding
Immunizations
Hep B, DTap, Varicella, Hib Hib (meningitis), PCV, IPV, MMR, RV
Role of Nurse: immunizations
- education yourself
- listen
- educate caregivers (VIS), respect autonomy
- administer safely
- comfort measures
- documentation
Dental care
- visit dentist after eruption of first tooth
- brush/wipe teeth twice a day with plain water, cloth, or soft toothbrush
Infant mortality
- 2014: 4 mil live births, 23000 died
- 6/1000 infants die before first birthday (5/1000 non hispanic whites, 11/1000 non hispanic blacks)
- US death rate has declined 13% since 2005; but twice as high for black infants than for white infants
- Causes: birth defects, preterm, maternal complications of pregnancy, SIDS, and unintentional accidents
Accidents
Falls - most common after 4 months
Burns - leading cause of death from unintentional accident in children ages 1-14
Swallowing and choking - liquids in small infants, small objects in larger infants
Biological agents, plants, toxins, MVA
Aspiration and Burns Injury Prevention
Aspiration: supervision, age appropriate toys, check clothing, avoid small objects (grapes, candy, hot dogs)
Burns: fire resistant clothing, covered hot drinks, hot water temperature at 120F, smoke detectors, handles of pots and pans turned back, sunscreen after 6 months, cover electrical outlets, fire extinguisher
Drowning and fall prevention
Drowning: never leave unattended, fence around pools
Falls: Supervision, safety gates on stairs, no walkers, secure heavy items to prevent tip overs, side rails up, use straps of seats
Poisonings and Suffocation prevention
Poisonings: program poison control center into phone, post on phone/fridge
Store in original containers, out of reach, locked
Suffocation: avoid plastic bags, no balloons, safe sleep, cords on curtains, blinds, etc.
Other health promotion strategies
-Learn CPR, smoke free enviro, home safety checks - with changes in dev, remove guns from home
